ࡱ> gih`!V(l0`_[xRMKQ=͌fp! 7- tQP-#j,)PAnkHԺ;q ja܏ysߌBpĐy"24WqV4j+kr6&JDz(by%'QJrK_PXOr䦾fnƲeh{K&-PNG  IHDR+kgAMAPLTEckks!!s!!{11{11JBJBZRZRkckc{sƭνRtRNS pHYsttfx dIDATx],^DZcs=Xi*ه" 5GIl}/[r;Ik#thnMthn$vp_ ݯWn+7ܞu#-$n -()]>-aԊ7J԰,ƶ~nS(XP?2Uͻ6L1m&݂niR؜ƭke:_-t@Kv})n'7m'v': -9X)%ZՐpԘtJ.˲tߓzlG>*_VԞԦ"K&ﻡG٠ dρq!a#b[,ؒH=cm)ERh:v]JNz-[Ug8 mS+0氵"2c*Q)}A:ZI~,:u`#63HNݺvE/X>_qq^>Y[9blVI>)5ے'zƁzxX~U(N@GvuaCR[Hh?]sjU۩Fǻp4jbmvWas3ivm2yh Ke9XH (Kŗԥ.hM Vze:;G=~кݼߋp?X &aݯvp_ ݯWnJR!أ(x bܼrN%T9__z1+S,zmvY]'ZyM¹8ԙ#!Y[|mLfhP_vMZtj߶Oq7ݼ(ϰGT0=A5[bE3rS[b~ 'a3e\8y&JY_z;vM-,1H%`b]6I%F2,2R?tXbͥeѾwkA8w(e-V_3m{B /2̯0:5fAG~ }lԤur4~h_yЏg?hHKhyS=Ĕh)u)qUBȜqϷޡ>Zu,ADzk:0/-9=ը";c̷xmAXΨUp{2E+5Hy>*z%!Ϸ=,-3Ud-wl6%!i<e?1݉[:<CƭUhЫݎk1ғ*gnӡp~m ܒE5믠:2)n?KUo2k4jun3ֵ{`\i 3KbYuAW4İ">.\so2zJ^}űZ:Ӹ)"e*ȇ"bXdc'C?L&,6E~Y2:Fwٓq{AFkș@J

yrTܾWcۭyR]n|thnMpOn+2P´T6TޑոE R m}[m4DN{xD% VRD!BM<[ڪn^,tAg {YQR<>g4֕BGw\W3' |tknHCg,>ŤH(Bx0TOK#x-ƬP;* /n|рD(ǨF2eJǹn;Idm2։ VKc8]_ pj4U8RJ;kMmĻc?9Q[$J d)0b_dRsV^]YNT0:R%g!8)5.15U '+u#|<}8ƳD#"٢I03ɟNdd2Z|kZ[s>bU&Q nn2ͷ8c3"Rgu #/^rO E4 zi>`۞75orɤCi'*XB 6R?rƦ'p뀫[ ZCU}^8"b3:Q CoqzU0Ow AS(Vwc,şa;)ݲo 7| dSm2}6<Gw\[劶N pG+Ee$LȦk? ,boI]0%&ͭpbeY3<[K36v Kк3[׮ HRcT0|c,e+Zq0_Tu/^q/Ix_ +\Eݜ[kA!mthn$vp_ ݯ >y2荸wrY[T' Q}j{zQ'ȳH^_ >A{[ƣo92bRk9[IL)uɟnۅԬUU)%c['3z[J;ەRկ?ܢ_9o'L08iH}C]7ǭ;E/hĘK>Wa/Ӭl.lFSK}][$9}﷯|qw)r*v{>:N?ۀ[o@ݯWn+J~%vp_ ݯWQ[{ ݯg!aªIENDB` (H(@  | 90Picture Word.Picture.80,Microsoft Word Picture0)$Photo Editor Photo MSPhotoEd.30@Microsoft Photo Editor 3.0 Photo`/ 0DTimes New Roman̳0~0DMonotype Sorts̳0~0  (2  @n?" dd@  @@``  h4 (  C/X2$V(l0b$Ʋeh{K&- 0e0e     A@  A1 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E|| q~@8g42d2d~0X vpip <4BdBdX <4!d!dg4-d-d~0R pp p? %O =/   ` 3` y3` ___>?" ddn2?nKdin[ d97P nEnA@ 9 dw n?" dd@   @@``@n?" dd@  @@``PZ < 7 n    ` p>PE933>E93.. % - %  ( >  L   # 0H(     BC DE F f11? @0    BCYDEF f11?X @  Nt#x ? 3F x RImproving Patient Access in a Family Practice Clinic at an Academic Medical CenterS S.  H#x ? F$ x RClick to edit Master text styles Second Level Third Level Fourth Level Fifth Level!     S  C x4$xCC1 ?$ff' x ]* 2(n77nn   C x$xCC1 ?$f/'  x _*(2(n77nn   C x$xCC1 ?$3B' x _*(2(n77nn x   `dΔ>? ? 3 Embossed.pot$    @  ( d L ? #  0H(    BCDE F f11?@   BC DEF f11?  @?  N ? FM x T Click to edit Master title style! !  Hd ?fAp x W#Click to edit Master subtitle style$ $!  C xĊCC1 ?$ff'  a* 2(n77nn #  C x$CC1 ?$f/'   c*(2(n77nn #   C xCC1 ?$3B'  c*(2(n77nn x   `dΔ>? ? 3| 0 <40(  Mw(    f(x1 ?   x =*    f)x1 ? @  x ?* d  c $ ?JP  xL   ft)x1 ? @0 x RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  # l1 ?  x =*   # ld1 ? @ x ?* H  0.k ? ̙33 qi / (    # lT%x1?9@  MetroHealth Medical Center Outpatient Treatment of Venous Thromboembolism with Low-Molecular-Weight Heparin Catalyst Initiative Improvement Project@8P2m6',6  # lA ?1?]F    f%x1?r : 9Background Conventional treatment consisted of: IV Heparin to prevent further clots Frequent blood draws during hospital stay LOS 5-7 days Proposed treatment consisted of: Injections given once or twice per day instead of IV Heparin Blood draws once a day at home or clinic Less time in hospital (LOS 1-2 days)  $%%\%!%% &\! hF    f&x1?  ,Aim of Project To provide safe outpatient management of patients with Venous Thromboembolism (VTE), including Deep Vein Thrombosis (DVT) and/or stable Pulmonary Embolism (PE), through the use of enoxaparin, a low-molecular-weight heparin (LMWH) which can be given by subcutaneous injection at home.X$% m%  # lt&x1?` ( - CATALYST INITIATIVE Quality Resource Unit@.8F2<0(   f&x1? .$ 3Barriers Increased drug cost (~ $300 for a 7 day supply) Lack of insurance for drug coverage Uninsured and underinsured patients Lack of reimbursement for Home Care Lack of routine retail pharmacy stocking< $%   f4'x1? 2; @Improvement Cycles Required Development of a Patient Education Program Development of a standardized follow-up system in the outpatient setting Involvement of multiple health care disciplines Resolution of cost issues<$% P  f'x1? 4E DConclusions / Results Patients admitted to MHMC with VTE can be safely and effectively treated as outpatients with LMWH after a short hospital stay Pre-Protocol Protocol Total patients 60 59 Related re-admits 4 3 Avg. Length of Stay 5.8 days 2.8 days Average days on protocol = 8 days$%$$%   BB   f'x1?y3{ qHow did we overcome the Barriers? Team developed pre-printed orders which included: Inclusion, exclusion criteria Weight-based LMWH dosing Initial oral blood thinner dosing Patient education materials Discharge Planning Orders Monitoring log Information on Indigent Medication Assistance Program Nursing and Physician Staffs were educated about the new protocolr"2%%C%"2C ?   fT(x1?4D|% !Team Members Marigel Constantiner (Team Leader) Matt Eisen (Facilitator) Sandie Amin (Facilitator) Robert Bahler Manoharan Balakrishnan Teresa Drocton Gaby El-Khoury Linda Horvath Cheryl Horvitz Marcia Kucler Kathy Lehman Thomas Lukens Margie Mazur Greg Palmer Lynette Seebohm Z $%   / # lA )?1?q`@D\ )x   `dΔΔ>> ? ̙33 0 xP ( 3  R  3 JP   I~  C tSI @0  I  H  0.k ? ̙33Nx[{lEfwzw}p-PP єBB"@ &>%=G j $F&|ЀDUCHLcCB Ucѐ(p~loףwTd~oٙy|;]GGu @[178-~L@ϷbSxp)K!TH.$7)S(! @.RPa|#F"=4 i4!C4i|G`5`Y,Mðmψ%wk)0+ g+iɴ'I>X))TS>r `>ƴAIF馶A]*<\`b;G09G}{ۧ1`ES}89![ 7#[>XC^P=L],y=R-/K-I~fK)fE Pz {8)=T-|HVCYiO rثn/4T;`/!"kY5 7NÐuA f5Xɢegf&NC̙-|NC>24#эKE= }#bpsx)\g 'QN.W%UvP#nD's7! @=;M)BlL 3 aVZpg%xJjʿfz^N3/jH(&b8g },|G~h4F 0{\fRcklX45zICƕ gG\Hc?c4WלݧW g6HB[3"mwigC.!KZU>I %K~rZ2le.C'PLbsBjehsp5&N3r}iPg\K>YBvU5lѢ- };zCxd!sbb28*X| l|$RP*z{jNa84ݰ6fTЄ}d6cV̮{79XSsdϬmnkp L0{YE\zIa${kua.7WZOr؇{^k_ )y&8 ة4`gσX üN4jn-sS{KAAAAAA]Hg4eŚ{!=8ϨiڝMn [ǭ G^[>9(œ&?nr?I rrB| וu`pKNi%B$6mxF>d|1qؐ&i͝V}8:/?sx?s*MQugJ9!K3ݝI=F?y6xI&a<)@ޙD{y03#z_9S^.|Il0Q_`pϑk],XeVL~Cx a,-`+p1fGTyh7&ypώG[?{[1;hp@ύOtIǾWL(|76 :@lV] ^+ bϨQ!+&l#XU0ϴJ|}5r/(@WU[X)b pg4iEhuR󏮝+(((((((((((((M8v>a.=BkgH&u]dZ_̿~eޔ!c./Ps`~;L%蚁cxUWR9̃Y\ȵ=iI+((((((((((((<ܹ|x]iU4j K6 dp`l` C<aa `I0e `d 8sW3ýJRzyOխ3kT*uW%~}yZ-{c=ysdy:`WoO޼yZzMcc&C.,O|NB 01@ 9<p |O|4Tx:gtg>lg8lx>s x/|> o[n|v/ x1K/pK_2^p/ |~W𵀯o|#,5^'x 7p-7\o|;; .w~]_ ^p-vkxp _o}wR Og}}.Ć3Fj,[ϋX oXp|lkqo}[pܗAϹw[˶?ϗ~2O㊽FEzN~8هΝ? y N.{ԭ~Ω{8{-|+M4gj /۷t&߱>n}‰o=ϟ> /9Kw^<ҥ.]z2ʕkW~ڵ]~ƍ' : ƌ&Ö-~ɸ4f̘lk-{mm3pSkÚc=_-سb=7fC5١Ppvf8;T3tqvۡlRsu4p6ȡk,l|эZ–(ku,5ߧD%[~V2=& 3hY(,It6ͺr:nKcƔqc-prXJyr}GezX^`w ISB8SJJݼ,L#g֟mi8ELA_AxbR!, PճHQ̊aIZ8Q,6E,GklIoѠV)rr]  iC=0 :Y f9ƶg4)66E#WJT )ya#wdIR~8NlR7bixZ q'j/cl2C',u,u:bZ[4v$YR)wlL|xyYV *|ggR4"2ڌv&xn`֑4$꺒>iYu~U':?reN_7g!GLfyV-5ճ6Ѭ>(u6-}c>^Fs8EhlfSq~tϨnKl̝W5ճn*5ͳc݅eDՅnXp[m:c:ōsJA_pvUsdeΗ@ O*\7i*V{\/5>WK4]'@.5gP~οțU>8!w  [tQy<~b~WSɿpね.3P̳C5١Ppvf8{ 7)u숥X4s{GNpԘNκiqa@DIE>J1wB[s $%-֞Gg1׵+$B! ڊj֍>2;oYWYEFeCy|g]gE/U2E* *ǙY.λZ gi,{ԃ[ȵ9,8޳Ή)=7mٗWsqAX⯘Mz0 ))HOCnjh銋8vبY lI%H'_P*L!)`4ƞ>%msa\EFඦE/bMwR!6ljs㡚ynY-gɳRziY03oZⳬq/)XQ\c_ ۩b!s(CgڳR/҂K̙ E7P*\av-Dg1DIsx$:جKD_}+b"hxqE1} 鸣_;gڱJ1>2qY[dBr/y~=cVUˇMcIQV^؃N;jyj1o[p (qYgZ;+deT`Ëz.K!\*Zb>N,%mj,LE\E*Zph9iI3Yj҂8zgrR+W[KR0GNMS=Mg5oC^p3\'sҠb&/T 5Qz]jɃt^.YF l3qKTRք%%r>Eͳ(mJ/ԹЬ`g+ *c7BvɨΗ kebx' <]M.>zY;sqL˵FXP܌zE f Qy#]6ד/O*+[KS@ai}=,R0KZΥf8˺\$[3&WMc)I0I9Ytrv<7Cmlߺe<ۻ&m Zwݳm{?{so8 gjC5١ں8ύkԔ="=.Y޺rsvlٿouzѓέ8JZM C*G/k;u(^S}_\l>8. Fm]ͳ$P(8yc= TzͣFE8QE\ Dέo8e0ۋMrxsU(G(KY9WkuΑx]֓[p2k_ `I_t86iB Щ<|ciZqVJE.~3-^R?gk˳^#L.)`tPUkxpk#bC9\PD|}̺9yP5Ugz q +ϛ{9=Ϫ5>Y9֙pŁpŌtpxO5ݮ,œnkcLD752o0V ļ7Uu>ʧ+%%lZnzM.3 gjC5١Ppvf8;T3 gjv6֘1cc}2zF=Cpu`?zu'zuǧV>y%q-{|?Q~K?Y~ୀ_"o2W 5~vo~ ۀG];}pG? w Sc?9=%  ;x?O _e?ɛ0 ]Ko-%cp-z,z|)4*p)t>l @!`}yiE]_qzO |TGuquq0wY ߺ8(c.YW/[]b}Uc׮Y7_qƖ33vӵimKYSHnm{`z_f;l3 m6awf;l{5!hm 5ڊ_䁝 ى70NnBNl: uww% ݤ -0w~uH7'w~/L7wMuďotn=Zl{N3 mx?j5M{߭VϽ{`z_2F,: ۝XDcۙ=ɘw0B*:Z(Ib2B<$i JD@T}L)tuL3+Їd>nYT{ԀØMoZ嶈 )!*QK-ݺBI7}| /&4#MS8zΪh = G2KѺ3У8#Y2ҤC1|7'8сxmI*b1V4xfL9,8(r wWX6J$.9jyQ^R<\}SR1j,koQت}(#zE(v0OYG2~P99ȥсeR|qӫN5/evzk+<&F[(ȣu96^z˗pY6KJwuA(DEK*w\P6ÿሱe{C v'f~# ?BOE( |=vqؖDjǂubwE,e\1 xHʶR+>/j-R)EeQP,.>?Zu,;2[ıם`Uz)~~Pg)jMlkU7-O(e`#)ː^UܾI!3uwe:RH9W7r^[(xFYzhVZk8ZXp屪=Ipg]%b9xi Ǽ)eByW_Q#(Y%QXQT+x KkUe| W-_>O9HUJM#Ki7ʲ[kcdbo~SǼϪ˿љ es^DIٿZϣٜ1WaqUl,%e-e{u^Y{A30$>4fդ7W *J2G(bI1VA1,i,1iԱH 6xUWRْWGGd\ eg܍}Dd θL1>|Ə{_Qf[OHFȦhmUԼy; *M᳭#u|n/n:୎3̻N̿e9(Y u4&=λd>c`ouUz3xm#<5':G0FJ&0':YvOu1Ubt=ϑ?@ABCDEFGHIJKLMNOPQRSTUVWXYZ\]^_defkml[ _wScottScott՜.+,08    CustomThe MetroHealth Systemw> Times New RomanMonotype Sorts EmbossedMicrosoft Word Picture!Microsoft Photo Editor 3.0 PhUTʚ;2Nʚ;<4dddd{ 0:2___PPT9/ 0? %O =/ rb bm8 (H(@  | ;Picture Word.PotoPowerPoint Presentation  Fonts UsedDesign TemplateEmbedded OLE Servers Slide TitlesCurrent UsercSummaryInformation(;?PowerPoint Document( wDocumentSummaryInformation8h